Medicine
醫學
There is no alternative
沒有替代品
Virtually all alternative medicine is bunk; but the placebo effect is rather interesting
幾乎所有的替代醫學都是騙人的，但安慰劑效應相當有趣
May 19th 2011 | from the print edition
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IT IS, you might suppose, always good to have an alternative. In medicine, though, that is a controversial proposition. Alternative and complementary medicine are mostly quackery. Yet they are very popular. Clearly, they have something that mainstream medicine does not. The question is, what?
你可能會認為，任何事物最好都能有替代品。但在醫學界裡，這是一個富有爭議的議題。替代醫學幾乎全部都是騙人的治療。然而，他們卻很受歡迎。無疑地，他們有傳統醫生所沒有的獨到之處。問題就是他們的獨到之處是什麼？
A few treatments (mostly herbs containing active drug molecules) do have proven benefits. A few others look worthy of further investigation. But from acupuncture, via homeopathy, to 「quantum healing」, the vast majority, some 95%, offer nothing more than the placebo effect—the strange and inadequately explained tendency of certain medical conditions to respond to anything the patient thinks is directed at treating them, even when the treatment in question could not possibly have a direct effect on the disease.
少許治療（草藥通常含有有效的藥微粒）已被證明有療效。另一少部分貌似值得進一步研究。但是，從針灸、順勢治療到「量子治療」，絕大多數（約95％）的另類治療僅僅提供安慰劑效應——有些病情，如果病人認為治療會有任何的一種作用，那麼，病情就會有那種反應，儘管那個治療不可能最那個疾病有直接的作用。這個安慰劑效應是奇怪的，在醫學中還沒有足夠的解釋。
It is thus a great pity that Edzard Ernst, the first professor of alternative medicine (that is, real scientific professor) and the man who demonstrated that 95% of the industry was hokum, is about to retire early (see article). It is an even greater pity that funding to his department at Britain’s Exeter University looks likely to be cut. For the message needs to be broadcast that alternative medicine is a colossal waste of money. Globally, the industry is estimated to be worth some $60 billion a year. That is a lot to pay for placebos.
這有點可惜，因為證明了該行業裡的95%治療都是空話的首位非傳統醫學教授（更確切地說，科學教授，注意了，是真正的科學教授）即將提早退休。更可惜的是他所在的英國埃克塞特大學的這個系的資金支持可能會被砍掉。因為，世界需要廣泛傳播這個信息：非傳統醫學浪費巨額錢財。從全球來看，該行業一年的總估價為600億美元。也就是說人們為安慰劑支付了很多錢。
The world’s advertising-standards offices should thus crack down on bogus claims—including the idea that there is such a thing as 「alternative medicine」 in the first place. If it works, it is a medicine and should be regulated like one. If it doesn’t work, it isn’t a medicine. Whenever scientifically challenged celebrities, such as the Prince of Wales, waffle on about it in ways that suggest it is outside the realm of scientific scrutiny, they too should be denounced by academics and proper doctors.
因此，全球的廣告標準局應該嚴厲打擊虛假聲稱——首先就要打擊那個「有另類醫學這樣一個東西」的觀念。如果它見效，就意味著它是醫學而且應該要像其他醫學一樣進行監管。如果它不見效，就意味著它並不是醫學。每當有不懂科學的名人，例如，查爾斯王子在不同方式上對此胡說八道並建議讓非傳統醫學不接受科學的詳細監查，他們也應遭到學者和正派的醫生來聲明它是無效的並加以譴責。
That should not, however, blind those proper doctors to the one thing, among all the claptrap, the so-called alternative does have to offer. Placebos can bring relief, especially from nerve-related problems like pain and depression. They may also reach further than that. There is growing evidence that the strength of a person’s immune system is affected by his mental state, too: a healthy mind really does count, especially in an unhealthy body. You do not necessarily have to dress up placebos in the trumpery of alternative medicine: studies show placebos also work when patients are just given fake pills that they think are proper medicines and even when they know they are placebos. But the alternative-medicine industry plainly excels as a placebo delivery service.
不過，這不能讓那些正派的醫生視而不見一件事，在所有的譁眾取寵的東西中所謂的非傳統醫學也有其獨到之處。安慰劑能讓人得到緩解（痛苦）和安慰，尤其在疼痛和憂鬱等相關問題上。它的效用可能不止如此。還有進一步證據顯示，精神狀態會影響一個人的免疫系統：心理健康十分重要，特別身體不健康的人。你不必對中看不中用的替代醫學中安慰劑的添油加醋：研究表明當病人吃無藥效的假藥片。但他們認為這是真藥，安慰劑也有藥效，即使病人明明知道那是安慰劑（也一樣）。但是替代治療行業獨到之處主要在於安慰的發送。
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多一點家訪，多一點傾聽
For all the nonsense, the industry follows the famed advice of Sir William Osler, one of the fathers of (real) medicine: 「care more particularly for the individual patient than for the especial features of the disease.」 The industrialisation of patient care often depersonalises the process of treatment. The average length of an appointment with a British family doctor, for example, is eight minutes. However, complementary and alternative therapists—perhaps because they are usually private—take much longer. Patients reward them by believing (wrongly but usefully) that it is the specifics of the therapy that are bringing relief, rather than the attention itself. Proper doctors could learn from this. Veterans have always known the importance of a bedside manner. More home visits and fewer telephone consultations might work wonders.
儘管(替代醫學)是空話，但該行業遵照（傳統）真正醫學之父之一的Sir William著名意見：「應該多關注病人本身，而不是關注疾病的特徵。」 隨著病患照料的工業化，常常使治療過程去個性化。例如，一位英國家庭醫生的面談時間只有八分鐘。然而，替代治療專家——也許因為他們通常是私人的——投入更多。病人以信念（錯誤的但有用的）作為報答。這是治療本身的效果，而不僅僅只是安慰的效果。傳統醫生也應當從中學習。 經驗豐富者一直明白醫生對病人態度的重要性。多一些家訪，少一些電話，電話諮詢可能會創造奇蹟。